With the benefit of the latest advances in medical research and technology, children with renal (kidney) disease can grow up to be healthy, productive members of society. Comprehensive care is not just a matter of providing a single procedure or a few pills. The specialized care required for children calls for a team of professionals trained and experienced in the diagnosis and treatment of children and adolescents with renal failure, including: pediatric nephrologists, renal nurse specialists, social workers, child life specialists, and nutritionists. In addition, consultation may be required with many other pediatric subspecialists and surgeons.
Causes of renal disease
Only one normal, functioning kidney is sufficient to support good health, so both kidneys must be affected for chronic kidney failure to occur. The three major causes of renal disease in children are structural abnormalities of the urinary tract occurring before birth; hereditary disease; and glomerulonephritis (inflammation of the kidneys).
Structural abnormalities include blockage of the kidneys at various levels. These can often be detected by fetal ultrasound. Obstruction of urinary drainage at an early stage of fetal development causes ongoing damage and abnormal development of kidney structure. The correction of a blockage later in life may not be able to reverse damage to the kidneys.
Posterior urethral valves is a structural abnormality in boys in which a membrane blocks the flow of urine out of the bladder. The spectrum of disease resulting from this condition ranges from stillbirth or birth with kidney failure, to mild conditions that may not be detected until adolescence.
Another congenital structural abnormality that may lead to kidney failure is vesicoureteral reflux. In this condition, which occurs in boys and girls, urine flows from the bladder back into the kidneys rather than being excreted when the bladder contracts.
Hereditary diseases can cause cyst formation and kidney failure in children. Alport's syndrome, which primarily affects boys, causes auditory nerve damage leading to deafness and kidney failure. Infantile polycystic kidney disease has an autosomal recessive pattern of inheritance (meaning both parents are healthy but carry the trait for the disease in their genes). It may result in kidney and liver failure at an early age. Adult polycystic kidney disease has an autosomal dominant pattern of inheritance (meaning one of the parents has the disease). The name is misleading because it can cause kidney failure in infants and children as well as adults.
Glomerulonephritis includes a group of conditions in which the child's own immune system causes damage to the kidneys. Previously healthy adolescents and older children are the most frequently affected. Systemic lupus erythematosus (SLE), an autoimmune disease primarily affecting teenage girls and young women, is the best known of these conditions. …